​Sarju Bharucha, JD:Welcome Dr. Safeek. You have occupied a wide spectrum of roles within the US healthcare system - doctor, medical director, previous hospital part-owner, Joint Commission surveyor, Malcolm Baldrige Board of Examiners, health system Chief Medical Officer, book author, speaker, and software developer. You also made the short list for US Undersecretary of Health, and it’s now been four years since you founded The SafeCare Group and a year of SafeCare magazine, so it’s fitting that we interview with you. Before we get into the aspects of SafeCare, I’m curious about the path that led you to the creation of The SafeCare Group.Yisrael Safeek, MD, MBA:Well my story starts as an indigent South American immigrant who was destined to not amount to much. Before I came to the US, I never handled a telephone or knew what a television set was. I was only ten when I got my first job brushing out insects, poison, and kerosene from used lemonade bottles. When a bottle exploded in my hand, I was so afraid they were going to punish me, I ran home screaming with fear, leaving a trail of blood on the streets. Later, I worked as child security guard, carrying a baton that was taller than me. When the thieves came I hid in fear. As a teenager, I lived alone in my native country while my entire family escaped to other South American countries from a brutal, Communist dictator. Yes, I have a whole lot to be thankful for…coming to the US, a country that gave me a chance to work as a janitor and clean the entire college cafeteria for my meals while I get a university education. While the other college students partied, I worked as a lab assistant in between classes, painted homes and waited tables on the weekend, and finished my degree in less than three years, majoring in Biology and Chemistry, magna cum laude. In a time when only the elite got into US medical schools, I earned a full one year scholarship to medical school. It was the only way I could afford to attend. I’m the first in my family to finish college, to go to medical school, to have an MBA. Yes, I am extremely grateful to the many angels who have helped me over the years. Now, it’s my turn to give back.SB:Why did you found The SafeCare Group?YS: It’s my way of giving back. The SafeCare Group exists because US healthcare leaders have failed patients. Outcomes have deteriorated over the last decade despite more regulations, more hospital mergers and alliances, and innovative technology. Billions of dollars are invested in healthcare each year, yet there is paltry improvement in patient safety. The question is why? If you take the three variables you’ll see they all have one obstacle in common – a handful of Group Purchasing Organizations, or GPOs. GPOs were supposed to offer healthcare important alternatives for cost-containment and reduction of medical errors. Much to the detriment of taxpayers, cost have escalated over the last decade, and patients and physicians do not benefit from novel, ground-breaking technologies that are forced out of the marketplace. I am always amazed when I hear people complain that information technology failed to produce life-saving results. That’s rubbish. There’s predictive analytics that potentially can mitigate adverse drug events that are kept out of hospitals because of greed. Take patient safety software for example, the process of getting them into hospitals is broken, favoring some GPOs and their vendor cohorts. GPOs are making a kill from administrative fees pushing poorly designed IT– some people call these snake oil - to CEOs who serve on their boards. The playing field is uneven, stacked against patients and physicians as mid-level hospital managers feel the pressure downstream to acquire GPO-preferred products. Another reason for The SafeCare Group... you mentioned I was a surveyor with The Joint Commission, an organization I admire immensely, so much so that I donated all my time offs and vacation for close to 10 years to learn what ails healthcare across this country. The Joint Commission allowed me to examine systems of care for compliance with CMS conditions of participation and earn deemed status. In the years I did this, I was fortunate to inspect many organizations - some rural, other single hospitals, yet others large world renowned health systems. While the majority seemed to be trying to provide safe and quality care, there were significant exceptions that bothered me. Some of these exceptions were big named health systems and had to do with gross patient safety breaches. It’s really amazing how a lot of these poor performing organizations were part of some GPO, and touted that alliance even while processes of care were fraught with vulnerabilities and systems were fragmented. Thirdly, as you know I’ve been a health system Chief Medical Officer, and have also served in numerous operations roles for various organizations. This has given me significant interaction with healthcare boards. While some hospital boards get it, I am never amazed at the paucity of understanding regarding leadership’s roles and responsibility in poor patient outcomes. While boards are not supposed to be interfering in day-to-day operations, it is hard to understand how a hospital board would ignore physicians’ concerns... like not being able to view nursing and ancillary notes in the medical record. I observed this at one hospital a full three years before the Ebola debacle involving the medical record at the Dallas hospital in 2014. In addition, most hospital boards are never privy to physician outcomes, not unless there’s a malpractice case, suspension of privileges, or a fair hearing with attorneys. It’s why we created OPPE Readiness App - to make it easier to spot susceptibilities earlier to help mitigate many of these disasters. Finally, through my appointment to the Board of Examiners for the Malcolm Baldrige Program through the US Department of Commerce, I got to evaluate health systems for the highest quality award in the world. At the time, I was the only physician serving with both Joint Commission and the Malcolm Baldrige Program, and was the first Kentucky physician appointed. Anyhow, in the half a decade I was an examiner, I noticed certain key characteristics of high reliability health systems, as well as private organizations like the Studer Group, whose application I examined. I realized that if I apply these key characteristics with patient safety outliers, there are bound to be improvements. We incorporated these into every aspect of The SafeCare Group operations –SafeCare Analytics, SafeCare Magazine, 100 SafeCare Hospitals, our people, our services, and support.SB: How is The SafeCare Group different from other companies?YS: We are not only different, we’re a disruptive force for the better. For starters, at The SafeCare Group we are a comprehensive entity: we innovate software, analyze data, and publish outcomes. Secondly, we are private – not beholden to Wall Street stockholders... no conflicts of interest, just loyal to our customer base we serve. As you know, we operate in a neighborhood where most of the other players are publicly traded for-profits with four-lettered stock tickers. While they have to take care of investors on Wall Street, SafeCare caters to hospitals on Main Street. There are also competitors who are not-for-profit, but they behave as for-profits having huge balance sheets at the end of the year. I believe the second biggest deceit in healthcare are the non-profit/not-for-profits that tout this status and rake in hundreds of millions in profits. Recently, I read a Johns Hopkins Bloomberg School of Public Health study showing seven of the top 10 most profitable hospitals in the United States are nonprofit facilities. It’s really mind boggling to me how companies can play this nonprofit/not-for-profit game but in reality, operate like large for-profit corporations, valuing profits over people, paying their leadership outrageous salaries. Another significant way we are different is through the fact that we charge just enough to cover our expenses. Our business model is to work with hospitals for patient safety. The SafeCare Group is offering real, bottom-line value to hospitals through advanced, automated and affordably priced medical software. We also have a money back guarantee with all our software. If after three months you are not satisfied, you get your money back. No questions asked. Tell that to the other healthcare software companies, their stockholders would go insane.SB:That is a unique business model in your industry, so please tell our readers about the mission of The SafeCare Group.YS: Our customers tell us it’s a noble mission. The SafeCare Group exists because of immense disappointment with the current healthcare establishment. Seems like year after year we hear and get the same humdrum from the same self-appointed patient safety and healthcare gurus, while preventable patient deaths and medical errors escalate. It’s also a mockery when some patient safety organizations claim to represent national patient safety interests, but exclude great ideas, great software, and most sadly, genuinely qualified people. Perhaps, they ought to remove ‘national’ from their title as they don’t represent everyone. The mission of The SafeCare Group is simply “A relentless commitment to improving healthcare quality, safety, and efficiency in outpatient and inpatient settings”. Our goal is building a large, independent, and high-performing organization that innovates software to help hospitals avoid CMS reimbursement penalties and remain Joint Commission compliant. Through honesty, trust, and integrity in all our work, we intend to produce high-performing EMR-based software that are easy to use, and affordable. To achieve this, we depend on high quality people offering value-added services as we innovate SafeCare software, analyze data, and share performance to improve outcomes.SB:You mentioned your innovations with SafeCare Analytics, can you elaborate more?YS: We offer a comprehensive suite of EMR-based analytical Software-as-a-Service (SaaS) applications that are easy as possible to implement, integrate, and deploy. Our SaaS solutions utilize SafeCare’s proprietary analytics to help hospitals improve with CMS inpatient and outpatient pay-for-performance programs as well as Joint Commission. These are CMS inpatient Hospital Value Based Program, Hospital Readmissions Reduction Program, Hospital Acquired Conditions Program, and CMS outpatient Merit-based Incentive Payment System. As you know, we offer the most comprehensive software for Joint Commission’s OPPE and with risk management functionality.SB: Can you elaborate on the software for Joint Commission OPPE compliance?YS: It’s the 24 hour, 365 days, EMR-based OPPE Readiness App. It’s very affordable and demonstrates compliance with Joint Commission OPPE and FPPE anytime, anywhere, anyplace. It featuresICME Easy Spot Technology that’s a God sent for doctors and hospital staff as they don’t have to waste time shuffling through pages. It also caters to health system interoperability and collaboration. As you know, I worked with a team at Joint Commission on the Medical Staff Systems Tracer - OPPE and FPPE. I also wrote the American College of Physician Executives book on OPPE and FPPE titled, Credentialing and Privileging for Accountable Care. The software incorporates best practices from numerous Joint Commission site visits from hospitals in over 40 states. One of the biggest headaches I had as a Chief Medical Officer was getting ready for regulatory site visits. I’m talking about staying up late in the wee hours of the mornings with hospital legal counsel trying to guess which practitioner file the inspectors were going to ask for and examine. Back then, we used SafeCare’s competitors’ products which were inadequate for the job. What a shame hospitals invested exorbitant amounts on useless products through GPOs that are labeled as OPPE software that didn’t do FPPE. Unlike SafeCare’s competitors, OPPE Readiness App was designed by people who know - former JACHO surveyors, and evaluates core competencies in 54 medical specialties with specialty-specific metrics. Big advantage – it also does FPPE even for allied Health - PAs, ANPs, and CRNAs.SB: Explain how SafeCare Analytics help with CMS Hospital Value Based Program.YS: This is our ValuTrax Isoftware which was designed for better performance with CMS Value Based Program by identifying critical admissions that affect care. It also identifies cost per episodes, outlier days, and process measures. The software actually analyzes outliers and calculates the financial burden to the hospital. Most of all, the practitioner gets to see this in addition to the CEO, COO, CFO etc.SB:How about the CMS Hospital Readmissions Reduction Program?YS: Similarly, ValuTrax II is an EMR-based SaaS using SafeCare propriety technology for Readmissions Reduction. The software targets key conditions and procedures, adverse drug events, and consultations overuse. It also analyzes and reports out on preventable admissions... a major game changer.SB:And how about the software for CMS Hospital Acquired Conditions Program?YS: This is ValuTrax III, another EMR based analytical software tool identifying patient safety conditions and outliers. It also monitors compliance the Joint Commission National Patient Safety Goals and of course, CMS Never Events. The software also calculates the financial burden to the hospital as a result of outlier analyses. Most of all, the practitioner gets to see the actual cost in dollars and becomes a more engaged player in the sandbox. As you know CMS has expanded cost to the outpatient arena as well.SB:Can you explain?YS: CMS recently released its proposed final rule for MACRA, the outpatient P4P arm that was under discussion when I made the short list for US Undersecretary of Health. SafeCare software tracks provider level opportunities associated with the Merit-based Incentive Payment System or MIPS. These are Quality Measures, Resource Use, Clinical Practice Improvement, and Advancing Care Technology. As an aside, SafeCare Analytics is also moving into population health. MIPS is aligned with PULSE, our Clinical Integration software.SB:Tell us more about Clinical Integration software.YS: This software is physician interactive. Docs get to go through their performance in over 250 quality, patient safety, and efficiency of care metrics. For doctors, there is a feeling of involvement, aligning them with the hospital’s goals and national expectations. Makes the job of the Chief Medical Officer, department heads, PI folks, and chairpersons easier.SB:Do you do live software demonstrations for potential clients?YS: As a matter of fact, yes. Most of the demos are from programs we created to assess software features. All the contact information is on our website or hospitals can contact for a live demo:support@safecareanalytics.comSB: SafeCare also does public US government data analysis. What data does SafeCare analyze?YS: SafeCare Analytics analyze publicly available data for our annual 100 SafeCare Hospitals campaign, analyzing data of close to 4,500 hospitals. This is our third year of reporting on the performance of US hospitals. The ratings recognize hospitals at three levels: 100 SafeCare Hospitals®over 400 beds; 100 SafeCare Hospitals® 100-400 beds; and 100 SafeCare Hospitals® under 100 beds.SB: Is 100 SafeCare Hospitals an award?YS: Unlike other designations, 100 SafeCare Hospitals® is not an award that hospitals receive; it is a distinction that hospitals earned based upon performance in the evidenced-based metrics of the Affordable Care Act. These metrics are found in Hospital Value Based Program, Hospital Readmissions Reduction Program, and Hospital-Acquired Conditions Reduction Program. We started this hospital recognition program in 2013, when only six hospitals endorsed it. Now, we are up to 42, and have hospital leaders calling why their hospital did not make the listings. Only about six percent of US hospitals earn the prestigious 100 SafeCare Hospitals® distinction.SB: Other hospital ratings don’t utilize these metrics. Why those particular metrics?YS: These are the evidence-based metrics that are required under section 3025 of the Affordable Care Act. These metrics are so important that hospitals which perform poorly on them receive a financial penalty from the CMS. The distinguished medical and legal experts who designed, developed, and implemented the Affordable Care Act believed that a listing of high performing hospitals in the specific metrics of HVBP, HRRP, and HACRP would promote strong incentives to improve care. The SafeCare Group adopted this framework for the 100 SafeCare Hospitals® methodology, as it truly represented holistic, balanced, evidence based metrics in the areas of “Quality of Care”, “Patient Safety”, and “Efficiency of Care”. Each year, we publish the 100 SafeCare Hospitals® in our SafeCare magazine publication.SB:Why SafeCare magazine? Why now?YS: After more than a quarter century in healthcare, I came to the conclusion that healthcare leaders – CEOs and boards - need to get acquainted with topics that are important for safe patient outcomes. This makes sense as they also hold the purse strings. With few exceptions like The Mayo Clinic, The Cleveland Clinic, and Johns Hopkins, the US stands as one of the few countries in the world where hospitals are run by non-physicians. While a medical education is not a requirement for running a safe hospital, acquaintance with patient safety issues and solutions does help immensely. The goal of SafeCare mag is to be a unique voice in its coverage on the people, ideas, organizations and novel technologies affecting safe and quality healthcare to healthcare’s leaders, especially C-level executives and other decision makers. In 2007, Pam May, JD and I wrote and submitted the paper, “Protocols, Prompters, Bundles, Checklists, and Triggers: Synopsis of a Preventable Mortality Reduction Strategy” to several healthcare “quality” journals... they didn’t even bother to acknowledge it. After being rejected over a two year period, it was peer reviewed and printed by the Journal of Physician Executives. After that, Healthcare Financial Management Magazine requested and reprinted it for all US CFOs to read as it featured SafeCare CAUTI Bundle and 12-point I AM FOR SAFETY Surgical Checklist. This is why SafeCare magazine exists today, to share information as an easy reader, to make a difference in patient safety.SB:In all your years working in patient safety, what has surprised you most?YS: The biggest coming to mind is an inspection visit to a “world renowned” hospital when I was with The Joint Commission. When I say “world renowned” I’m referring to a top 10 rating in the nation... rated by others of course. The hospital’s leadership constantly kept reminding the inspection team of these ratings. That all sounds fine until you know that the hospital had over 250 findings after a five day inspection. They had patient safety lapses like using concentrated heparin to flush central lines, lack of two person hand-off from the blood bank, blood administration without staff present in the initial moment, pharmacy not reviewing pre-procedure orders for medications, no post-procedure retrospective review, medications drawn up and mixed in a syringe and stored for later use without the strength of the dose on the label, lack of defined processes for prompt resolution of patient grievances, just to name a few. Mind you, with every finding they would remind us, “this is a top 10 hospital,” and they displayed a lot of hostility to the inspection team as the findings were piling up. I can tell you of another occasion when we - the inspection team - arrived at this great Midwestern health system and was asked to go home. Days earlier ahead of Joint Commission survey, the health system was visited by the Centers of Medicare and Medicaid and had over 1,000 findings. Some involved rape of a patient in a psych ward. Truly sad. It’s why The SafeCare Group supports the metrics of the Affordable Care Act... to hold leadership accountable.SB:What one thing in healthcare you would change tomorrow, if you could?YS: The close to half a million preventable healthcare deaths that occur each year in US hospitals. Of course that would mean getting rid of some of the GPOs. Not all, but some GPOs tout how proper they are, how they are re-engineering healthcare, how they are improving healthcare quality. Yet, medical errors are now a primary cause of deaths in the US, tripling over the last few years for Medicare patients alone. I refer to these GPOs as Government Procurement Oligarchs and their hospital executive cohorts as opportunists because they prey on federal dollars, profiteering from US taxpayer funding. Some GPOs are rife with conflict of interest, almost a kickback scheme, skirting on the edge of the law for profit. The healthcare business is dirty, but the relationship between certain GPOs and hospital CEOs reek. I believe the biggest treachery in healthcare are the non-profit/not-for-profits hospital systems that “partner with a Wall Street traded monopoly” fueled by taxpayer-funded CMS under the guise of improving healthcare quality to rake in millions in loot. For the sake of patient safety, this monopoly must stop, and allow patients, nurses, and doctors to have true choice. I encourage the Federal Trade Commission and the US Senate to formally examine whether GPO administrative fees are increasing patient costs and forcing innovative software technology out of the marketplace. We urge them to repeal the safe harbor provisions afforded to for-profit GPOs. In the interim, someone should do an article calling out this corrupt relationship...title it, “The Fleecing of US Healthcare”.SB:You mentioned earlier preventable patient deaths and medical errors increasing. How has this affected you personally?YS: Significantly. I remember one night when I took my wife in labor to the so-called “baby factory” in Lexington, Kentucky to deliver our youngest. They featured the verse from the Book of Jeremiah, ‘“Before I formed you in the womb I knew you.’ The doctor on call started tocolytics, stopped the labor and left, no explanation, never mind I’m a physician myself. I called an OBGYN friend and took my family to another hospital where labor was promptly re-initiated with Pitocin. Even our dear Lord must be in awe of the mockery of using his good name, causing a child to suffer the horrors of hypoglycemia, and blood-shot eyes. I don’t want to bore our readers but medical errors can happen to doctors as well. I still wince when I think of the time I was prescribed spinal decompression therapy after rupturing three lumbar discs all at one time. Instead of stretching the spine, the machine went the other direction, compacting. Ouch. You would think that this bizarre scenario belonged to a Freddy Krueger movie. The SafeCare Group is my small contribution to improving care for patients.SB:Before we go, can you briefly discuss the global impact of The SafeCare Group?YS: We are reaching out to a worldwide audience and just started collaboration with several other countries. The SafeCare Group also endorsed the World Health Organization Hand Hygiene Self-Assessment Framework, and the World Medical Association Statement on Physicians Well-Being as these have patient safety ramifications. After one year, the online version of SafeCare magazine is viewed by people in 69 countries, and the printed version by a great number of hospital CEOs.SB: Who inspires you?YS: My guardian angels, Nazmoon and Mark Safeek. She was orphaned both parents at age five, and taught herself to read and write. He lost his dad at age eleven, becoming the primary bread winner of his family. They made sacrifices for me to achieve what they never really had a chance to. These two people I am eternally indebted to.SB: What’s the future of The SafeCare Group?YS: We’re having a banner year, growing strongly in all dimensions – SafeCare Analytics, 100 SafeCare Hospitals, and SafeCare Magazine. We remain focused on and excited about building a large, independent organization that remains focused on delivering software to help hospitals improve. As is the case with many high-performing organizations, we look for opportunities to add to our capabilities and we have strategic discussions with a range of entities.SB:Where should people go to get in touch with you?YS: Our web site is safecaregroup.com